BCACP Ambulatory Diabetes Management 2

Question 1

A patient with T2DM and an eGFR of 38 mL/min/1.73m² is currently on metformin 1000 mg twice daily. What is the most appropriate action?

Accepted Answer

Discontinue metformin

Answer

Continue metformin at current dose

Answer

Reduce metformin dose to 500 mg twice daily

Answer

Switch to metformin XR 2000 mg daily

Question 2

Which GLP-1 receptor agonist is FDA-approved for once-weekly subcutaneous injection and has demonstrated cardiovascular outcome benefits in the LEADER trial?

Accepted Answer

Liraglutide

Answer

Exenatide extended-release

Answer

Semaglutide

Answer

Dulaglutide

Question 3

A patient with T2DM develops recurrent genital mycotic infections after starting empagliflozin. What is the mechanism behind this adverse effect?

Accepted Answer

Increased urinary glucose promotes fungal growth

Answer

Immune suppression from glucosuria

Answer

Direct antifungal resistance induction

Answer

Increased urinary pH favoring Candida

Question 4

For a patient with T2DM and established ASCVD, which medication class has the strongest evidence for reducing cardiovascular mortality as a first add-on to metformin?

Accepted Answer

GLP-1 receptor agonists or SGLT2 inhibitors

Answer

DPP-4 inhibitors

Answer

Sulfonylureas

Answer

Thiazolidinediones

Question 5

A pharmacist is counseling a patient starting insulin glargine. Which statement about insulin glargine storage is correct?

Accepted Answer

Once opened, insulin glargine can be kept at room temperature for up to 28 days

Answer

Opened vials must be discarded after 14 days

Answer

Unopened pens can be stored at room temperature indefinitely

Answer

Insulin glargine must always be refrigerated, even after opening

Question 6

Which of the following best describes the mechanism of action of pioglitazone in T2DM?

Accepted Answer

Activates PPAR-gamma to improve insulin sensitivity in peripheral tissues

Answer

Inhibits hepatic glucose production via AMPK activation

Answer

Stimulates pancreatic beta-cell insulin secretion

Answer

Inhibits intestinal glucose absorption

Question 7

A patient with T2DM has an A1C of 9.2% and is asymptomatic. According to ADA standards, what is the most appropriate initial pharmacotherapy approach?

Accepted Answer

Start dual combination therapy

Answer

Start lifestyle changes alone for 3 months

Answer

Start metformin monotherapy

Answer

Initiate insulin immediately